Document Type : Original Article

Authors

Department of Rehabilitation and Movement Sciences, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA

Abstract

INTRODUCTION: Physical therapists provide important services to improve physical health for
the general population; however, physical therapy interventions are less utilized with underserved
populations such as those with severe mental illness (SMI). The quality of services for these
populations is impacted in part by negative provider attitudes and lack of preparation to work with
the SMI population. This study examined the impact of structured educational field experience on the
physical therapist’s attitudes and knowledge about working with the SMI population. This will inform
future educational practices to best prepare students to provide quality of healthcare to the population.
MATERIALS AND METHODS: Seven graduates of a doctor of physical therapy (DPT) program
from a Mid‑Atlantic University in the United States who participated in an SMI service‑learning (SL)
experience completed a semi‑structured qualitative interview in 2016. Questions about how the
experience impacted their current work were asked. Interviews were digitally recorded, transcribed,
and examined using interpretive phenomenological analysis. Coding and investigator triangulation
were conducted. All interviews reached thematic saturation.
RESULTS: The graduated DPT students reported attitudinal changes toward people with SMI through
qualitative interviews. They reported an improvement in their skills, greater competence to work with
the SMI population, and an increased focus in the use of person‑centered services.
CONCLUSIONS: The results of this study suggest that DPT students gain an understanding of both
the SMI population and themselves during SL. Using SL as part of the DPT educational curriculum
can offer students and the opportunity to build confidence in working with the SMI population. SL
can also improve their skills and attitudes toward the population, key areas that are identified as
barriers to receiving quality physical healthcare among the SMI population.

Keywords

1. Stubbs B, Soundy A, Probst M, Parker A, Skjaerven LH,
Lundvik Gyllensten A, et al. Addressing the disparity in physical
health provision for people with schizophrenia: An important role
for physiotherapists. Physiotherapy 2014;100:185‑6.
2. Bartels S DR. Health promotion programs for people with serious
mental illness (Prepared by the Dartmouth Health Promotion
Research Team) Washington, D.C: SAMHSA‑HRSA Center for
Integrated Health Solutions; 2012. Available from: https://niatx.
net/pdf/wicollaborative/HealthPromoSMI.pdf. [Last accessed
on 2020 Apr 12].
3. DeHert M, Correll CU, Bobes J, Cetkovich‑Bakmas M, Cohen D,
Asai I, et al. Physical illness in patients with severe mental
disorders. I. Prevalence, impact of medications and disparities
in health care. World Psychiatry 2011;10:52‑77.
4. Parks J, Svendsen D, Singer P, Foti ME. Morbidity and mortality
in people with serious mental illness: National Association of
State Mental Health Program Directors (NASMHPD) Medical
Directors Council; 2006. Available from: https://www.nasmhpd.
org/sites/default/files/Mortality%20and%20Morbidity%20
Final%20Report%208.18.08.pdf. [Last accessed on 2020 Apr 12].
5. Dandridge T, Stubbs B, Roskell C, Soundy A. A survey of
physiotherapy students’ experiences and attitudes towards
treating individuals with mental illness. Int J Ther Rehabilit
2014;21:324‑30.
6. Pope C. Recovering mind and body: A framework for the role
of physiotherapy in mental health and well‑being. J Public Ment
Health 2009;8:36‑9.
7. Corrigan PW, Wassel A. Understanding and influencing the
stigma of mental illness. J Psychosoc Nurs Ment Health Serv
2008;46:42‑8.
8. Horsfall J, Cleary M, Hunt GE. Stigma in mental health: Clients
and professionals. Issues Ment Health Nurs 2010;31:450‑5.
9. Knaak S, Mantler E, Szeto A. Mental illness‑related stigma
in healthcare: Barriers to access and care and evidence‑based
solutions. Healthc Manage Forum 2017;30:111‑6.
10. van Hasselt FM, Oud MJ, Loonen AJ. Improvement of care
for the physical health of patients with severe mental illness:
A qualitative study assessing the view of patients and families.
BMC Health Serv Res 2013;13:426.
11. Adshead S, Collier E, Kennedy S. A literature review exploring
the preparation of mental health nurses for working with people
with learning disability and mental illness. Nurse Educ Pract
2015;15:103‑7.
12. Barney SC, White L. Service‑learning with the mentally Ill:
Softening the stigma. Michigan J Community Service Learning
2010;16:66‑77.
13. Happell B, Platania‑Phung C, Scott D. What determines whether nurses provide physical health care to consumers with serious
mental illness? Arch Psychiatr Nurs 2014;28:87‑93.
14. Happell B, Gaskin CJ, Byrne L, Welch A, Gellion S. Clinical
placements in mental health: A literature review. Issues Ment
Health Nurs 2015;36:44‑51.
15. Henderson C, Noblett J, Parke H, Clement S, Caffrey A,
Gale‑Grant O, et al. Mental health‑related stigma in health care
and mental health‑care settings. Lancet Psychiatry 2014;1:467‑82.
16. King S. Can simulation utilizing standardized patients ease
anxiety and enhance self‑efficacy in nursing students working
with patients experiencing mental illness? A Pilot study. All Regis
University Theses; 2017.
17. Probst M, Peuskens J. Attitudes of Flemish physiotherapy
students towards mental health and psychiatry. Physiotherapy
2010;96:44‑51.
18. Gyllensten AL, Sevensson B, Bjorkman T, Hansson L,
Leufstadius C, Bejerholm U, et al. Attitudes in healthcare students
towards mental illness: A pre‑ and post multicenter university
program survey. Int J Allied Health Sci Practice 2011;9:1‑8.
19. Bringle RH J. Reflection in service learning: Making meaning or
experience. Evaluation/Reflection; 1999.
20. Yorio PL, Ye FF. A meta‑analysis on the effects of service‑learning
on the social, personal, and cognitive outcomes of learning.
Academy Manag Learning Educ 2012;11:9‑27.
21. Gitlow L, Flecky K. Integrating disability studies concepts into
occupational therapy education using service learning. Am J
Occup Ther 2005;59:546‑53.
22. Wise HY. Effect of community‑based service learning on
professionalism in student physical therapists. J Phys Ther Educ
2013;27:58‑64.
23. Yildirim M, Demirbuken I, Balci B, Yurdalan U. Beliefs towards
mental illness in Turkish physiotherapy students. Physiother
Theory Pract 2015;31:461‑5.
24. Teherani A, Martimianakis T, Stenfors‑Hayes T, Wadhwa A,
Varpio L. Choosing a qualitative research approach. J Grad Med
Educ 2015;7:669‑70.
25. Center for Community Health and Development UoK.
Community building skills toolbox; 2020. Available from: https://
ctb.ku.edu/en/table‑of‑contents. [Last accessed on 2020 Apr 12].
26. Gill KJ, Zechner M, Zambo Anderson E, Swarbrick M, Murphy A.
Wellness for life: A pilot of an interprofessional intervention
to address metabolic syndrome in adults with serious mental
illnesses. Psychiatr Rehabil J 2016;39:147‑53.
27. Pietkiewicz I, Smith JA. A practical guide to using interpretative
phenomenological analysis in qualitative research psychology.
Psychol J 2012;20:7‑14.
28. Smith JF, Larkin M. Interpretative phenomenological analysis:
Theory, method and research. SAGE Publications 2009.
29. Saldaña J. The coding manual for qualitative researchers. SAGE
Publications; 2015.
30. Dowling M, Cooney A. Research approaches related to
phenomenology: Negotiating a complex landscape. Nurse Res
2012;20:21‑7.
31. Carter N, Bryant‑Lukosius D, DiCenso A, Blythe J, Neville AJ. The
use of triangulation in qualitative research. Oncol Nurs Forum
2014;41:545‑7.
32. Fusch PI, Ness LR. Are we there yet? Data saturation in qualitative
research. Qualitative Rep 2015;20:1408‑16.
33. Firth J, Siddiqi N, Koyanagi A, Siskind D, Rosenbaum S,
Galletly C, et al. The lancet psychiatry commission: A blueprint
for protecting physical health in people with mental illness. Lancet
Psychiatry 2019;6:675‑712.